EVALUATION OF THE EFFECTIVENESS OF EVIDENCE BASED OXYTOCIN/PITOCIN PROTOCOL

Abstract:

Purpose and Aims: This research aims to evaluate the outcomes of an evidence-based (EB) oxytocin check-list protocol implemented by the Birth Center Unit at one of the Seattle area hospitals in December 2009. Selected maternal and fetal outcomes will be compared before and after the protocol implementation using data from electronic records. Background: Oxytocin, a synthetic medication commonly utilized during labor augmentation, joined the list of high-risk medications that significantly heighten patient harm when used incorrectly. Protocols for administration of other high-alert medications have already been implemented nationwide, while an oxytocin protocol has not. Currently, the administered dosages and increments between infusions are inconsistent in various care settings, and often reflect provider’s experiential knowledge and preference. Implementation and evaluation of oxytocin/pitocin protocols is imperative. Problem: To date, there are no published studies that evaluated effectiveness of EBP oxytocin protocols on maternal and infant outcomes. The site in which the protocol was implemented has not evaluated the effectiveness of the new protocol yet. Significance: Currently, the United States ranks 29th in infant mortality (Centers for Disease Control, 2008) and 41st in maternal mortality among developed countries (World Health Organization, 2007). Half of all births in the United States utilize oxytocin during labor and delivery (Freeman & Nageotte, 2007). The recent implementation of an oxytocin protocol checklist at the hospital is one of the key strategies to provide safe and quality care to laboring patients and to provide a safeguard for nurses and other providers. Design and Methods: The ethical approval to conduct the study was granted by the University IRB and the study site. It is a retrospective electronic chart review investigation. We hypothesized that there will be a reduction in adverse outcomes following the implementation of the oxytocin check-list protocol on all selected variables with the strict adherence to the new protocol. To determine a statistically powerful sample size at 80% with alpha=.05, we will analyze before and after proportional data based upon our primary outcome of Late Decelerations using OpenEpi Sample Size for a Proportion or Descriptive Study calculator. If the calculated sample exceeds the number of charts available, which is 540 participants based upon 30 charts per month for 18 months, we will conduct a pilot study and enroll at least 60 participants per protocol. Data collection and analysis will take place in October 2011 through December 2011. Data will be analyzed using SPSS #18 statistical software. Descriptive statistics and independent samples T-tests will be performed to detect differences in outcomes before and after Oxytocin protocol implementation. Implications: The recent implementation of an oxytocin protocol checklist at the study site is one of the key strategies to provide safe and quality care to laboring patients and to provide a safeguard for nurses and other providers. Findings will add new information about the effectiveness of evidence based oxytocin protocol for the study site. It will also contribute new information regarding administration for nation wide use.